Activation of the coagulation system is an important manifestation of the systemic inflammatory response of the host to infection. Levi M, et. al. 1999 N Engl J Med.; 341:586-592. Several in vivo models have been used to dissect the molecular mechanisms that contribute to coagulation activation by bacteria and bacterial products, including intravenous injection of low dose lipopolysaccharide (LPS) into healthy humans. Van der Poll T et. al., 1999 Cohen J, Marshall J, ed. The Immune Response in the Critically Ill. Berlin: Springer-Verlag; 335-357. Tissue factor, a glycoprotein expressed on endothelial cells and monocytes upon stimulation, plays an essential role in coagulation activation induced by LPS or bacteria in vivo, as demonstrated by abolishment of this response by inhibitors of tissue factor. de Jonge E, et. al., 2000 Blood 95:1124-1129; Creasey A A, et. al. 1993 J Clin Invest.; Carr C, et al. 1994 Circ Shock. 44:126-137; Levi M, et al. 1994 J Clin Invest. 93:114-120. Mitogen-activated protein kinases (MAPKs), such as p38 MAPK, participate in intracellular signaling cascades that mediate inflammatory responses to infectious and noninfectious stimuli. Herlaar E, et al. 1999 Mol Med Today 5:439-447; Ono K, et. al. 2000 Cell Signal 12:1-13. Recent in vitro studies have implicated one of these kinases, p38 MAPK, in the regulation of tissue factor expression on monocytes, endothelial cells, and smooth muscle cells. Chu A J, et al. 2001 J Surg Res. 101:85-90. Blum S, et al. 2001 J Biol. Chem. 276:33428-33434; Eto M, et. al. 2002 Circulation 105:1756-1759; Herkert O, et. al. 2002 Circulation; 105:2030-2036.
The p38 kinase inhibitors have been discussed in the literature and have been disclosed in U.S. Pat. Nos. 6,319,921, 6,358,945, 5,716,972, U.S. Pat. No. 5,686,455, U.S. Pat. No. 5,656,644, U.S. Pat. No. 5,593,992, U.S. Pat. No. 5,593,991, U.S. Pat. No. 5,663,334, U.S. Pat. No. 5,670,527, U.S. Pat. Nos. 5,559,137, 5,658,903, U.S. Pat. No. 5,739,143, U.S. Pat. No. 5,756,499, U.S. Pat. No. 6,277,989, U.S. Pat. No. 6,340,685, and U.S. Pat. No. 5,716,955; and PCT applications WO 92/12154, WO 94/19350, WO 95/09853, WO 95/09851, WO 95/09847, WO 95/09852, WO 97/25048, WO 97/25047, WO 97/33883, WO 97/35856, WO 97/35855, WO 97/36587, WO 97/47618, WO 97/16442, WO 97/16441, WO 97/12876, WO 98/25619, WO 98/06715, WO 98/07425, WO 98/28292, WO 98/56377, WO 98/07966, WO 98/56377, WO 98/22109, WO 98/24782, WO 98/24780, WO 98/22457, WO 98/52558, WO 98/52559, WO 98/52941, WO 98/52937, WO 98/52940, WO 98/56788, WO 98/27098, WO 98/47892, WO 98/47899, WO 98/50356, WO 98/32733, WO 99/58523, WO 99/01452, WO 99/01131, WO 99/01130, WO 99/01136, WO 99/17776, WO 99/32121, WO 99/58502, WO 99/58523, WO 99/57101, WO 99/61426, WO 99/59960, WO 99/59959, WO 99/00357, WO 99/03837, WO 99/01441, WO 99/01449, WO 99/03484, WO 99/15164, WO 99/32110, WO 99/32111, WO 99/32463, WO 99/64400, WO 99/43680, WO 99/17204, WO 99/25717, WO 99/50238, WO 99/61437, WO 99/61440, WO 00/26209, WO 00/18738, WO 00/17175, WO 00/20402, WO 00/01688, WO 00/07980, WO 00/07991, WO 00/06563, WO 00/12074, WO 00/12497, WO 00/31072, WO 00/31063, WO 00/23072, WO 00/31065, WO 00/35911, WO 00/39116, WO 00/43384, WO 00/41698, WO 00/69848, WO 00/26209, WO 00/63204, WO 00/07985, WO 00/59904, WO 00/71535, WO 00/10563, WO 00/25791, WO 00/55152, WO 00/55139, WO 00/17204, WO 00/36096, WO 00/55120, WO 00/55153, WO 00/56738, WO 01/21591, WO 01/29041, WO 01/29042, WO 01/62731, WO 01/05744, WO 01/05745, WO 01/05746, WO 01/05749, WO 01/05751, WO 01/27315, WO 01/42189, WO 01/00208, WO 01/42241, WO 01/34605, WO 01/47897, WO 01/64676, WO 01/37837, WO 01/38312, WO 01/38313, WO 01/36403, WO 01/38314, WO 01/47921, WO 01/27089, DE 19842833, and JP 2000 86657.
For the most part, such compounds have been indicated as being useful in treating cytokine mediated diseases such as those related to inflammation. Marin et al discusses the issue of whether p38 MAPK is involved in thrombin-induced endothelial proinflammatory functions including chemokine production. Blood, 1 Aug. 2001, Vol. 98 (3) 667-673. Until the present invention however, knowledge of the role of p38 MAPK in activation of coagulation and fibrinolysis has not been available.